Category: Research

People are not stupid

published date
September 28th, 2006 by

People are not stupid

A new survey reveals the public’s level of awareness of medical errors and steps patients are taking to prevent errors or mitigate the damage caused:

Substantial numbers of Americans report taking certain actions aimed at improving the coordination of care and reducing the likelihood of a medical error. These include: checking the medication given by their pharmacist against the doctor’s prescription (70%); bringing a list of all their medications to a doctor’s appointment (54%); and bringing a friend or relative to a doctor’s appointment to help ask questions (45%).

These are all excellent ideas and I’m heartened that so many people are taking action. The harder –but even more critical– thing to do is to have an assertive, knowledgeable person who is committed to your health maintaining a vigil at your bedside when you are in the hospital. The survey takers didn’t ask, but I’ll bet a lot of people are figuring that out, too.

Read the full Kaiser Family Foundation/AHRQ survey here.

Vaccines for non-fatal conditions

published date
September 26th, 2006 by

Vaccines for non-fatal conditions

From CNN (Vaccine aims to wipeout ear, sinus infections)

U.S. researchers said Tuesday that they are starting trials of a new vaccine aimed at wiping out childhood ear and sinus infections and many cases of bronchitis in adults.

Unlike virtually all other vaccines on the market, this one will not be aimed at saving lives, but at preventing nuisance illnesses, the researchers said.

“We are now in an era where we look to vaccines that make life better,” said Dr. Michael Pichichero, a professor of microbiology, immunology, pediatrics, and medicine at the University of Rochester Medical Center, who is leading the trial.

Now that we have developed technologies to fight fatal illnesses it is easier to use similar strategies for things that are troublesome but not life-threatening. Be on the lookout for similar advances in ADHD and PMS.

Thanks to Mickey.

“It’s good for the male organ,” my grandmother said

published date
September 20th, 2006 by

“It’s good for the male organ,” my grandmother said

My maternal grandmother (“Nana”) was an interesting and opinionated woman. She once caused a stir among the residents of my hard-to-impress freshman dorm at Wesleyan by arriving in leather pants.

Nana wasn’t shy about sharing her views about health and wellness, which were derived from a combination of the New York Times, her upbringing in New York City, conversations at the country club, and personal experience. Quite a bit of what she said was on the mark. She stayed active throughout her life, hitting a hole-in-one while in her mid-70s, and maintaining a youthful attitude. When friends of hers in their late 70s bought a new car and told her, “this one should see us out,” she was horrified and said “they are as good as dead” if that’s how they felt.

Nana was a big fan of the cranberry. She had a summer home next to a cranberry bog and made an arrangement with the bog’s owner that allowed her to pick the edges of the bog that the mechanical harvester couldn’t get to. When we were growing up she sent bags of cranberries to the extended family. I grew up eating homemade cranberry bread, cranberry muffins, and cranberry sauce.

Somewhere along the line Nana must have heard something about the research suggesting that cranberries were effective against urinary tract infections, although her interpretation had a slight twist:

“Cranberries are good for the male organ,” she used to tell my brothers and me in the presence of my grandfather. We never argued.

Nana’s not alive anymore, but she would have been excited to read the recent news on cranberries. Nana didn’t bother reading the Boston Globe, so someone might have had to point out the story, “Does Cranberry Juice Prevent Urinary Tract Infections?

The queen of cranberry science, Amy Howell, an associate research scientist at Rutgers University in Chatsworth, N.J., said that overall, research suggests that eight to 10 ounces a day of cranberry juice cocktail drink, sweetened with either sugar or artificial sweetener, has been shown clinically to reduce urinary tract infections by 50 percent. For years, people thought cranberry juice might combat urinary tract infections by making urine more acidic, thus making it harder for bacteria to grow. Now, thanks to the work of Howell and others, it is known that a chemical in cranberries called proanthocyanidin blocks infections by coating E. coli, the major culprit, so that it cannot stick to cells in the bladder. “If you prevent the adhesion, the bacteria won’t multiply and cause infection,” Howell said.

Nana was also a big fan of blueberries. We used to go “berrying” with her in the woods before other houses were built nearby. I don’t remember hearing anything special about their health benefits from her, but as a blueberry lover I was heartened to read:

A similar version of proanthocyanidin is found in blueberries, said Dr. Kalpana Gupta, assistant professor of medicine at Yale University School of Medicine.

Who knows, maybe we’ll soon see research suggesting that cranberry juice is “good for the male organ” after all. Look out, Viagra!

Who will subscribe to journals of negative results?

published date
September 17th, 2006 by
Who will subscribe to journals of negative results?Thanks to SimulConsult CEO, Mickey Segal, MD, PhD for this post.

There is clear value to journals of negative results because they correct a bias towards publishing correlations:

A handful of journals that publish only negative results are gaining traction, and new ones are on the drawing boards.

“You hear stories about negative studies getting stuck in a file drawer, but rigorous analyses also support the suspicion that journals are biased in favor of positive studies,” says David Lehrer of the University of Helsinki, who is spearheading the new Journal of Spurious Correlations.

After a slow start in 2002, that journal is receiving more and better papers, says Dr. Olsen. One found that, contrary to other reports, the relative length of the bones of a woman’s index finger and ring finger may not be related to her exposure to testosterone in utero. Another found that a molecule called PYY doesn’t have a big influence on body weight; another, that variations in a gene that earlier studies had associated with obesity in mice and in American and Spanish women isn’t linked to obesity in French men or women.

Hopefully, each of these reports kept researchers, including those at drug companies, from wasting time looking for ways to repair the consequences of the supposed genetic association. But it isn’t clear that any would have been published without the new journal.

These reports of negative results are very important, but will people subscribe to journals of negative results? This is a good example of papers that should be published in free online journals.

Questionable correlations between a gene and cancer are the bread-and-butter of NOGO, the Journal of Negative Observations in Genetic Oncology, which Dr. Kern edits. “Fully half [of discoveries] of novel mutations in tumors, we found, were not confirmed in the subsequent literature,” he says. “You expect to see follow-ups if the claims held up, so the fact that we didn’t casts doubt on the original claim. But that wasn’t explicitly reported.”

Why are scientists coy about publishing negative data? In some cases, says Dr. Kern, withholding them keeps rivals doing studies that rest on an erroneous premise, thus clearing the field for the team that knows that, say, gene A doesn’t really cause disease B.

I once spent months trying to reproduce, without success, a paper in a top journal claiming that lipids had huge effects on the nervous system. I even flew overseas to visit the lab of the guy making the claim and made liposomes in his lab and brought them back. In the end I concluded that the effects were due to the solvents used to make the liposomes. I ran this hypothesis by the author of the original paper and he told me that solvents aren’t interesting, but lipids were interesting. I didn’t publish my negative results, and subsequently heard that others before and after me had failed to reproduce the results.

Having a forum to report negative results is important, but it is not clear that journals of negative results are a better place to publish than online free journals.

Nature opens the peer review door a crack. Will anyone step through?

published date
September 14th, 2006 by

Nature opens the peer review door a crack. Will anyone step through?

An article in today’s Wall Street Journal (Journal Nature Opens Peer-Review Process to Comments Online) describes and experiment by the journal Nature:

Nature, one of the world’s most prestigious scientific research journals, has embarked on an experiment of its own.

In addition to having articles submitted for publication subjected to peer reviews by a handful of experts in the field, the 136-year-old journal is trying out a new system for authors who agree to participate: posting the paper online and inviting scientists in the field to submit comments praising — or poking holes — in it.

Lay readers can see the submitted articles as well, but the site says postings are only for scientists in the discipline, who must list their names and institutional email addresses. Nature says its editors screen out those they find irrelevant, intemperate or otherwise inappropriate.

Meanwhile, the papers also make their way through the journal’s traditional peer-review gauntlet. Nature says it’s taking both sets of comments into account when deciding whether to publish.

Sounds like a potentially promising development that could spread to medical journals. That could be useful, for example, if reviewers used the opportunity to more heavily scrutinize industry-sponsored submissions. I asked Mickey for his view:

It is interesting that it makes the paper available more quickly. This may be a crucial element to attract people to view the papers and possibly comment. Such a system is used in economics, where the crucial release of a paper is into pre-publication review that is viewed by many people. However, I don’t see a single comment on the 10 pages that are listed on the Nature site.
What I like about this approach is that it associates comments to the article text. An alternate model is bloggers talking about papers, but the problem there is that the comments are scattered in many places and hard to find.
This is an interesting move by a prominent journal such as Nature, which can hope to get reader participation because of its prominence the same way the Wall Street Journal’s “Best of the Web Today” column gets submissions in part because of the prominence of the Wall Street Journal. Less prominent journals would be better served by the independent blogger approach.
It will be interesting to see which approach wins. The continued prominence of journals such as Nature depends on it. In the past such journals had advantages that have been reduced by the ability to measure impact of papers not just by the prominence of the journal but by counting citations of the paper. If the blogging model beats the group review model as illustrated by this effort by Nature the prominent journals will have lost much of their prominence.